A comparison of the socio-economic determinants of growth retardation in South African and Filipino infants

Objective: To examine the association between household socio-economic status (SES) at birth and poor infant growth such as small for gestational age (SGA) and stunting across two different socio-cultural settings: South Africa and the Philippines. Design: Data were from two longitudinal birth cohorts, the Birth to Twenty (Bt20) study in South Africa and the Cebu Longitudinal Health and Nutrition Survey (CLHNS) in the Philippines. Subjects: Bt20 infants (n 2293 total; reduced to 758 (SGA), 450 (stunting 1 year) and 401 (stunting 2 years)) and CLHNS infants (n 2513 total; reduced to 2161 (SGA), 1820 (stunting 1 year) and 1710 (stunting 2 years)). Results: CLHNS infants were significantly more likely to be born SGA (20.9 v. 11.7%) and be stunted at 1 year (32.6 v. 8.7%) and 2 years (48.9 v. 21.1%) compared with Bt20 infants. Logistic regression analyses showed that SES (index) was a significant predictor of stunting at 1 and 2 years of age in the CLHNS cohort. SES (index or individual variables) was not a significant predictor of SGA in either cohort, or of stunting in the Bt20 cohort. Maternal education, ownership of a television and toilet facilities were all independent predictors of stunting in the CLHNS cohort. Conclusions: The social and economic milieu within the Philippines appears to place CLHNS infants at greater risk of being born SGA and being stunted compared with Bt20 infants. The present research highlights the importance of investigating the individual SES variables that predict infantile growth faltering, to identify the key areas for context-specific policy development and intervention

Association of socioeconomic status change between infancy and adolescence and blood pressure in South African young adults: Birth to Twenty Cohort

OBJECTIVE. Social epidemiology models suggest that socioeconomic status (SES) mobility across the life course affects blood pressure. The aim of this study was to investigate the association between SES change between infancy and adolescence, and blood pressure, in young adults, and the impact of early growth on this relationship. SETTING. Data for this study were obtained from a ‘Birth to Twenty’ cohort in Soweto, Johannesburg, in South Africa. PARTICIPANTS. The study included 838 Black participants aged 18 years who had household SES measures in infancy and at adolescence, anthropometry at 0, 2, 4 and 18 years of age and blood pressure at the age of 18 years. METHODS. We computed SES change using asset-based household SES in infancy and during adolescence as an exposure variable, and blood pressure and hypertension status as outcomes. Multivariate linear and logistic regressions were used to investigate the associations between SES change from infancy to adolescence, and age, height and sex-specific blood pressure and hypertension prevalence after adjusting for confounders. RESULTS. Compared to a persistent low SES, an upward SES change from low to high SES tertile between infancy and adolescence was significantly associated with lower systolic blood pressure (SBP) at the age of 18 years (β=−4.85; 95% CI −8.22 to −1.48; p<0.01; r2=0.1804) after adjusting for SES in infancy, small-for-gestational-age (SGA) and weight gain. Associations between SES change and SBP were partly explained by weight gain between birth and the age of 18 years. There was no association between SES mobility and diastolic blood pressure, mean arterial pressure or hypertension status. CONCLUSIONS. Our study confirms that upward SES change has a protective effect on SBP by the time participants reach young adulthood. Socioeconomic policies and interventions that address inequality may have the potential to reduce cardiovascular disease burden related to BP in later life

Comparison of the dietary components of the Planetary Health Diet Index (PHDI), Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH).

Comparison of the dietary components of the Planetary Health Diet Index (PHDI), Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH).</p

S1 Methods -

BackgroundThe Planetary Health Diet Index (PHDI) measures adherence to the sustainable dietary guidance proposed by the EAT-Lancet Commission on Food, Planet, Health. To justify incorporating sustainable dietary guidance such as the PHDI in the US, the index needs to be compared to health-focused dietary recommendations already in use. The objectives of this study were to compare the how the Planetary Health Diet Index (PHDI), the Healthy Eating Index-2015 (HEI-2015) and Dietary Approaches to Stop Hypertension (DASH) relate to cardiometabolic risk factors.Methods and findingsParticipants from the National Health and Nutrition Examination Survey (2015–2018) were assigned a score for each dietary index. We examined disparities in dietary quality for each index. We used linear and logistic regression to assess the association of standardized dietary index values with waist circumference, blood pressure, HDL-C, fasting plasma glucose (FPG) and triglycerides (TG). We also dichotomized the cardiometabolic indicators using the cutoffs for the Metabolic Syndrome and used logistic regression to assess the relationship of the standardized dietary index values with binary cardiometabolic risk factors. We observed diet quality disparities for populations that were Black, Hispanic, low-income, and low-education. Higher diet quality was associated with improved continuous and binary cardiometabolic risk factors, although higher PHDI was not associated with high FPG and was the only index associated with lower TG. These patterns remained consistent in sensitivity analyses.ConclusionsSustainability-focused dietary recommendations such as the PHDI have similar cross-sectional associations with cardiometabolic risk as HEI-2015 or DASH. Health-focused dietary guidelines such as the forthcoming 2025–2030 Dietary Guidelines for Americans can consider the environmental impact of diet and still promote cardiometabolic health.</div

Characteristics of eligible participants with two days of dietary recall data, NHANES 2015–2018^b'*'.

Characteristics of eligible participants with two days of dietary recall data, NHANES 2015–2018b'*'.</p

Predicted probability of cardiometabolic risk factor by quintile of Planetary Health Diet Index, Healthy Eating Index-2015, and Dietary Approaches to Stop Hypertension value among undiagnosed participants only, National Health and Nutrition Examination Survey 2003–2018*,^†.

* Survey-weighted logistic regression models were adjusted for age, sex, income, education, race/ethnicity, and total energy intake.† * p‡ Contrast is from Stata’s postestimation margins, dydx command and represents percentage point reduction in predicted probability from Quintile 1 to Quintile 5. (DOCX)</p

Radar plots of median component scores for Planetary Health Diet Index (PHDI), Healthy Eating Index-2015 (HEI-2015), and Dietary Approaches to Stop Hypertension (DASH), National Health and Nutrition Examination Survey 2015–2018.

* All dietary pattern component scores range 0–10 unless otherwise noted. † Component score range: 0–5. (TIF)</p

Predicted standardized PHDI, HEI-2015, and DASH value by sociodemographic characteristics, NHANES 2015–2018^b'*',^†.

Predicted standardized PHDI, HEI-2015, and DASH value by sociodemographic characteristics, NHANES 2015–2018b'*',†.</p

Criteria used to define binary cardiometabolic risk factor outcomes.

Criteria used to define binary cardiometabolic risk factor outcomes.</p

Predicted change in continuous and binary cardiometabolic risk factors per one standard-deviation change in PHDI, HEI-2015, and DASH, NHANES 2003–2018^b'*'.

Predicted change in continuous and binary cardiometabolic risk factors per one standard-deviation change in PHDI, HEI-2015, and DASH, NHANES 2003–2018b'*'.</p